Abstract
As outlined in other chapters of this book, the stigma and discrimination associated with mental illness remain a major burden on people with mental illness, their families, and society. Reducing the stigma and increasing the empowerment and well-being of people with mental illness should therefore be a priority for health services and society in general. In order to achieve these goals, effective anti-stigma strategies and interventions are needed. In this chapter, we will discuss strategies to tackle three types of stigma: public stigma, self-stigma, and structural discrimination. Briefly, public stigma refers to members of the general public endorsing negative stereotypes and discriminating against people with mental illness (Corrigan 2005; Rüsch et al. 2005; Thornicroft 2006); self-stigma occurs if people with mental illness internalize negative stereotypes, leading to diminished self-esteem, self-efficacy, and demoralization (Corrigan et al. 2009); and structural discrimination implies rules and regulations in society that intentionally or unintentionally disadvantage stigmatized individuals (Hatzenbuehler and Link 2014); see Chap. 3 for further details. This chapter is based on recent original articles, systematic reviews cited in the relevant sections, as well as previous narrative reviews (Rüsch et al. 2011; Rüsch and Corrigan 2012; Thornicroft et al. 2015).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Allbright AL (2005) 2004 employment decisions under the ADA title I – survey update. Ment Phys Disabil Law Report 29:513–516
Angermeyer MC, Holzinger A, Carta MG, Schomerus G (2011) Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. Br J Psychiatry 199:367–372
Beck AT, Rush AJ, Shaw BF, Emery G (1987) Cognitive therapy of depression. Guilford Press, New York
Brohan E, Elgie R, Sartorius N, Thornicroft G (2010) Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 122:232–238
Brohan E, Gauci D, Sartorius N, Thornicroft G (2011) Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: the GAMIAN-Europe study. J Affect Disord 129:56–63
Campbell NN, Heath J, Bouknight J, Rudd K, Pender J (2009) Speaking out for mental health: collaboration of future journalists and psychiatrists. Acad Psychiatry 33:166–168
Clement S, Lassman F, Barley E, Evans-Lacko SE, Williams P, Yamaguchi S, Slade M, Rüsch N, Thornicroft G (2013) Mass media interventions for reducing mental health-related stigma. Cochrane Database Syst Rev 7:CD009453
Cook JE, Purdie-Vaughns V, Meyer IH, Busch JT (2014) Intervening within and across levels: a multilevel approach to stigma and public health. Soc Sci Med 103:101–109
Corrigan PW (2004) Don’t call me nuts: an international perspective on the stigma of mental illness. Acta Psychiatr Scand 109:403–404
Corrigan PW (2005) On the stigma of mental illness: practical strategies for research and social change. American Psychological Association, Washington, DC
Corrigan PW (2006) Impact of consumer-operated services on empowerment and recovery of people with psychiatric disabilities. Psychiatr Serv 57:1493–1496
Corrigan PW, Larson JE, Michaels PJ, Buchholz BA, Del Rossi R, Fontecchio M, Castro D, Gause M, Krzyżanowski R, Rüsch N (2015) Diminishing the self-stigma of mental illness by Coming Out Proud. Psychiatry Research 229:148–154
Corrigan PW, Lundin R (2001) Don’t call me nuts! Coping with the stigma of mental illness. Recovery Press, Chicago
Corrigan PW, Penn DL (1999) Lessons from social psychology on discrediting psychiatric stigma. Am Psychol 54:765–776
Corrigan PW, Rao D (2012) On the self-stigma of mental illness: stages, disclosure, and strategies for change. Can J Psychiatr 57:464–469
Corrigan PW, Watson AC (2002) The paradox of self-stigma and mental illness. Clin Psychol Sci Pract 9:35–53
Corrigan PW, Markowitz FE, Watson AC (2004) Structural levels of mental illness stigma and discrimination. Schizophr Bull 30:481–491
Corrigan PW, Watson AC, Gracia G, Slopen N, Rasinski K, Hall LL (2005) Newspaper stories as measures of structural stigma. Psychiatr Serv 56:551–556
Corrigan PW, Larson JE, Rüsch N (2009) Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry 8:75–81
Corrigan PW, Morris S, Larson JE, Rafacz J, Wassel A, Michaels P, Wilkniss S, Batia K, Rüsch N (2010) Self-stigma and coming out about one’s mental illness. J Community Psychol 38:1–17
Corrigan PW, Rafacz J, Rüsch N (2011) Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatry Res 189:339–343
Corrigan PW, Morris SB, Michaels PJ, Rafacz JE, Rüsch N (2012) Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv 63:963–973
Corrigan PW, Kosyluk KA, Rüsch N (2013a) Reducing self-stigma by coming out proud. Am J Public Health 103:794–800
Corrigan PW, Sokol KA, Rüsch N (2013b) The impact of self-stigma and mutual-help programs on the quality of life of people with serious mental illnesses. Community Ment Health J 49:1–6
Dunion L, Gordon L (2005) Tackling the attitude problem. The achievements to date of Scotland’s ‘See Me’ anti-stigma campaign. Ment Health Today March: 22–25
Ehde DM, Dillworth TM, Turner JA (2014) Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol 69:153
Evans-Lacko S, Brohan E, Mojtabai R, Thornicroft G (2012) Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychol Med 42:1741–1752
Evans-Lacko S, Henderson C, Thornicroft G (2013a) Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009–2012. Br J Psychiatry Suppl 55:s51–s57
Evans-Lacko S, Henderson C, Thornicroft G, McCrone P (2013b) Economic evaluation of the anti-stigma social marketing campaign in England 2009–2011. Br J Psychiatry Suppl 55:s95–s101
Evans-Lacko S, Malcolm E, West K, Rose D, London J, Rüsch N, Little K, Henderson C, Thornicroft G (2013c) Influence of Time to Change’s social marketing interventions on stigma in England 2009–2011. Br J Psychiatry Suppl 55:s77–s88
Friedrich B, Evans-Lacko S, London J, Rhydderch D, Henderson C, Thornicroft G (2013) Anti-stigma training for medical students: the Education Not Discrimination project. Br J Psychiatry Suppl 55:s89–s94
Fung KM, Tsang HW, Cheung WM (2011) Randomized controlled trial of the self-stigma reduction program among individuals with schizophrenia. Psychiatry Res 189:208–214
Gawronski B, Bodenhausen GV (2006) Associative and propositional processes in evaluation: an integrative review of implicit and explicit attitude change. Psychol Bull 132:692–731
Greenwald AG, Poehlman TA, Uhlmann E, Banaji MR (2009) Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. J Pers Soc Psychol 97:17–41
Griffiths KM, Carron-Arthur B, Parsons A, Reid R (2014) Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry 13:161–175
Hadlaczky G, Hökby S, Mkrtchian A, Carli V, Wasserman D (2014) Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta-analysis. Int Rev Psychiatry 26:467–475
Hasson-Ohayon I, Mashiach-Eizenberg M, Elhasid N, Yanos PT, Lysaker PH, Roe D (2014) Between self-clarity and recovery in schizophrenia: reducing the self-stigma and finding meaning. Compr Psychiatry 55:675–680
Hatzenbuehler ML, Link BG (2014) Introduction to the special issue on structural stigma and health. Soc Sci Med 103:1–6
Hayes SC, Bissett R, Roget N, Padilla M, Kohlenberg BS, Fisher G, Masuda A, Pistorello J, Rye AK, Berry K (2004) The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behav Ther 35:821–835
Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J (2006) Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 44:1–25
Henderson C, Thornicroft G (2009) Stigma and discrimination in mental illness: time to change. Lancet 373:1930–1932
Henderson C, Thornicroft G (2013) Evaluation of the Time to Change programme in England 2008–2011. Br J Psychiatry Suppl 55:s45–s48
Jorm AF (2012) Mental health literacy: empowering the community to take action for better mental health. Am Psychol 67:231–243
Jorm AF, Wright A (2007) Beliefs of young people and their parents about the effectiveness of interventions for mental disorders. Aust N Z J Psychiatry 41:656–666
Jorm AF, Christensen H, Griffiths KM (2006) Changes in depression awareness and attitudes in Australia: the impact of beyondblue: the national depression initiative. Aust N Z J Psychiatry 40:42–46
Jorm AF, Kitchener BA, Sawyer MG, Scales H, Cvetkovski S (2010) Mental health first aid training for high school teachers: a cluster randomized trial. BMC Psychiatry 10:51
Kabat-Zinn J (1994) Wherever you go, there you are: mindfulness meditation in everyday life. Hyperion, New York
Kingdon DG, Turkington D (1991) The use of cognitive behavior therapy with a normalizing rationale in schizophrenia. Preliminary report. J Nerv Ment Dis 179:207–211
Kingdon DG, Turkington D (1994) Cognitive-behavioral therapy of schizophrenia. Guilford Press, New York
Kitchener BA, Jorm AF (2006) Mental health first aid training: review of evaluation studies. Aust N Z J Psychiatry 40:6–8
Kitchener BA, Jorm AF, Kelly CM (2010) Mental health first aid manual, 2nd edn. Orygen Youth Health Research Centre, Melbourne
Link BG, Phelan JC (2001) Conceptualizing stigma. Annu Rev Sociol 27:363–385
Link BG, Mirotznik J, Cullen FT (1991) The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided? J Health Soc Behav 32:302–320
Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC (2002) On describing and seeking to change the experience of stigma. Psychiatr Rehabil Skills 6:201–231
Livingston JD, Milne T, Fang ML, Amari E (2012) The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction 107:39–50
Lucksted A, Drapalski A, Calmes C, Forbes C, DeForge B, Boyd J (2011) Ending self-stigma: pilot evaluation of a new intervention to reduce internalized stigma among people with mental illnesses. Psychiatr Rehabil J 35:51–54
Luoma JB, Kohlenberg BS, Hayes SC, Fletcher L (2012) Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. J Consult Clin Psychol 80:43–53
Marlatt GA, Kristeller JL (1999) Mindfulness and meditation. In: Miller WR (ed) Integrating spirituality into treatment: resources for practitioners. American Psychological Association, Washington, DC, pp 67–84
Masuda A (2014) Mindfulness and acceptance in multicultural competency: a contextual approach to sociocultural diversity in theory and practice. New Harbinger Publications, Oakland
McCabe MP, Karantzas GC, Mrkic D, Mellor D, Davison TE (2013) A randomized control trial to evaluate the beyondblue depression training program: does it lead to better recognition of depression? Int J Geriatr Psychiatry 28:221–226
McCrone P, Knapp M, Henri M, McDaid D (2010) The economic impact of initiatives to reduce stigma: demonstration of a modelling approach. Epidemiol Psichiatr Soc 19:131–139
Mehta N, Clement S, Marcus E, Stona AC, Bezborodovs N, Evans-Lacko S, Palacios J, Docherty M, Barley E, Rose D, Koschorke M, Shidhaye R, Henderson C, Thornicroft G (2015) Evidence for effective interventions to reduce mental health-related stigma and discrimination in the medium and long term: systematic review. Br J Psychiatry 207:377–384
Mellor C (2014) School-based interventions targeting stigma of mental illness: systematic review. Psychiatr Bull 38:164–171
Metzl JM, Hansen H (2014) Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med 103:126–133
Mittal D, Sullivan G, Chekuri L, Allee E, Corrigan PW (2012) Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatr Serv 63:974–981
Morrison AP, Birchwood M, Pyle M, Flach C, Stewart SL, Byrne R, Patterson P, Jones PB, Fowler D, Gumley AI, French P (2013) Impact of cognitive therapy on internalised stigma in people with at-risk mental states. Br J Psychiatry 203:140–145
Pettigrew TF, Tropp LR (2006) A meta-analytic test of intergroup contact theory. J Pers Soc Psychol 90:751–783
Phelan JC, Yang LH, Cruz-Rojas R (2006) Effects of attributing serious mental illnesses to genetic causes on orientations to treatment. Psychiatr Serv 57:382–387
Pinfold V, Toulmin H, Thornicroft G, Huxley P, Farmer P, Graham T (2003) Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools. Br J Psychiatry 182:342–346
Purdie-Vaughns V, Steele CM, Davies PG, Ditlmann R, Crosby JR (2008) Social identity contingencies: how diversity cues signal threat or safety for African Americans in mainstream institutions. J Pers Soc Psychol 94:615–630
Rosen A (2006) Destigmatizing day-to-day practices: what developed countries can learn from developing countries. World Psychiatry 5:21–24
Roulstone A, Warren J (2005) Applying a barriers approach to monitoring disabled people’s employment: implications for the Disability Discrimination Act 2005. Disabil Soc 21:115–131
Rudman LA, Ashmore RD, Gary ML (2001) “Unlearning” automatic biases: the malleability of implicit prejudice and stereotypes. J Pers Soc Psychol 81:856–868
Rüsch N, Corrigan PW (2012) Stigma, discrimination, and mental health. In: Knifton L, Quinn N (eds) Public mental health. McGraw Hill Europe/Open University Press, New York, pp. 94–100.
Rüsch N, Angermeyer MC, Corrigan PW (2005) Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry 20:529–539
Rüsch N, Hölzer A, Hermann C, Schramm E, Jacob GA, Bohus M, Lieb K, Corrigan PW (2006a) Self-stigma in women with borderline personality disorder and women with social phobia. J Nerv Ment Dis 194:766–773
Rüsch N, Lieb K, Bohus M, Corrigan PW (2006b) Self-stigma, empowerment, and perceived legitimacy of discrimination among women with mental illness. Psychiatr Serv 57:399–402
Rüsch N, Corrigan PW, Wassel A, Michaels P, Larson JE, Olschewski M, Wilkniss S, Batia K (2009) Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use. Br J Psychiatry 195:551–552
Rüsch N, Todd AR, Bodenhausen GV, Corrigan PW (2010a) Biogenetic models of psychopathology, implicit guilt, and mental illness stigma. Psychiatry Res 179:328–332
Rüsch N, Todd AR, Bodenhausen GV, Corrigan PW (2010b) Do people with mental illness deserve what they get? Links between meritocratic worldviews and implicit versus explicit stigma. Eur Arch Psychiatry Clin Neurosci 260:617–625
Rüsch N, Evans-Lacko S, Clement S, Thornicroft G et al (2011) Stigma, discrimination, social exclusion, and mental health. In: Parker R, Sommer M (eds) Routledge handbook of global public health. Routledge, London, pp 394–401
Rüsch N, Abbruzzese E, Hagedorn E, Hartenhauer D, Kaufmann I, Curschellas J, Ventling S, Zuaboni G, Bridler R, Olschewski M, Kawohl W, Rössler W, Kleim B, Corrigan PW (2014a) The efficacy of Coming Out Proud to reduce stigma’s impact among people with mental illness: pilot randomised controlled trial. Br J Psychiatry 204:391–397
Rüsch N, Corrigan PW, Heekeren K, Theodoridou A, Dvorsky D, Metzler S, Müller M, Walitza S, Rössler W (2014b) Well-being among persons at risk of psychosis: the role of self-labeling, shame and stigma stress. Psychiatr Serv 65:483–489
Rüsch N, Müller M, Heekeren K, Theodoridou A, Metzler S, Dvorsky D, Corrigan PW, Walitza S, Rössler W (2014c) Longitudinal course of self-labeling, stigma stress and well-being among young people at risk of psychosis. Schizophr Res 158:82–84
Sartorius N, Schulze H (2005) Reducing the stigma of mental illness: a report from a global association. Cambridge University Press, Cambridge
Sawyer MG, Pfeiffer S, Spence SH, Bond L, Graetz B, Kay D, Patton G, Sheffield J (2010) School-based prevention of depression: a randomised controlled study of the beyondblue schools research initiative. J Child Psychol Psychiatry 51:199–209
Schnittker J (2008) An uncertain revolution: why the rise of a genetic model of mental illness has not increased tolerance. Soc Sci Med 67:1370–1381
Schomerus G, Matschinger H, Angermeyer MC (2014) Causal beliefs of the public and social acceptance of persons with mental illness: a comparative analysis of schizophrenia, depression and alcohol dependence. Psychol Med 44:303–314.
Segal SP, Silverman CJ, Temkin TL (2013) Self-stigma and empowerment in combined-CMHA and consumer-run services: two controlled trials. Psychiatr Serv 64:990–996
Shimotsu S, Horikawa N, Emura R, Ishikawa SI, Nagao A, Ogata A, Hiejima S, Hosomi J (2014) Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients. Asian J Psychiatry 10:39–44
Stuart H (2003) Stigma and the daily news: evaluation of a newspaper intervention. Can J Psychiatr 48:651–656
Stuart H (2006) Mental illness and employment discrimination. Curr Opin Psychiatry 19:522–526
Stuart H (2007) Employment equity and mental disability. Curr Opin Psychiatry 20:486–490
Thornicroft G (2006) Shunned: discrimination against people with mental illness. Oxford University Press, Oxford
Thornicroft A, Goulden R, Shefer G, Rhydderch D, Rose D, Williams P, Thornicroft G, Henderson C (2013) Newspaper coverage of mental illness in England 2008–2011. Br J Psychiatry Suppl 55:s64–s69
Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, Koschorke M, Shidhaye R, O’Reilly C, Henderson C (2016) Evidence for effective interventions to reduce mental health related stigma and discrimination. Lancet. doi:10.1016/S0140-6736(15)00298-6
Vaughan G, Hansen C (2004) ‘Like Minds, Like Mine’: a New Zealand project to counter the stigma and discrimination associated with mental illness. Australas Psychiatry 12:113–117
Wahl OF (1995) Media madness: public images of mental illness. Rutgers University Press, New Brunswick
Yamaguchi S, Wu SI, Biswas M, Yate M, Aoki Y, Barley EA, Thornicroft G (2013) Effects of short-term interventions to reduce mental health-related stigma in university or college students: a systematic review. J Nerv Ment Dis 201:490–503
Yanos PT, Roe D, Lysaker PH (2011) Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness. Int J Group Psychother 61:576–595
Yanos PT, Roe D, West ML, Smith SM, Lysaker PH (2012) Group-based treatment for internalized stigma among persons with severe mental illness: findings from a randomized controlled trial. Psychol Serv 9:248–258
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Rüsch, N., Xu, Z. (2017). Strategies to Reduce Mental Illness Stigma. In: Gaebel, W., Rössler, W., Sartorius, N. (eds) The Stigma of Mental Illness - End of the Story?. Springer, Cham. https://doi.org/10.1007/978-3-319-27839-1_24
Download citation
DOI: https://doi.org/10.1007/978-3-319-27839-1_24
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-27837-7
Online ISBN: 978-3-319-27839-1
eBook Packages: MedicineMedicine (R0)